20050030.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNER NAMEINAME OF ADDRESS TH
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1 TESCP Approved E3
0 C� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required El
Street Use Permit Roq'd E3
GITY zip TELEPHONE EXISTING - PROPOSED Inspection Required [3
Sidewalk Required E3
9&2-ol REQUIRED DEDICATION- Fr Underground
Wiring required E3
NAME METER SIZE LINE SIZE _rO. OF FIXTURES PRV REQUIRED
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STATE LICENSE NUMBER EXPIRATION D T CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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ROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
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NEW 1`11CA RESIDENTIAL r] PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
REMODEL PARKING LOT AREA G REVIEWED BY DATE
ID MULTIFAMILY SIGN REO'D I PROVIDED CL
GRADING FENCE 7
REPAIR CYDS . ( X FT) REMARKS FIRE MARSHAL
E] DEMOLISH TANK OTHER MUST BE PRESENT FOR
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3 DESCRIBE WORK TO BE DONE YES
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PROGRESS INSPECTIONS PER UBC 108/IBC109/iRC109 FINAL INSPECTION REO'D
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PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: 180 DAYS
1016 PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Ir Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
SSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION 6
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foes are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING.TO FOR INSPECTION lacelpt Is acknowledged in space provided.
WORKMEN'S COMPENSATIO��SURANCE AND RCW 18.27. ALS SIG TYRE DATE
GNAT RE (OWNER DATE SIGNED (425)
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A17ENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILARNAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL�FILE YELLOW- INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK -OWNER GOLD -ASSESSOR
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A. field inspection was conducted to determine final compliance. with approved plans. Final approval
denotes that there are no objections from -the above signed Department to the release'. of
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FAMED MAL INSPECTION OUTSTANDING ISSUES*
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RE -INSPECTED OUTSTANDING ISSUES. - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPEC TIONS